Fri Jun 14 2024

108 articles - From Friday Jun 07 2024 to Friday Jun 14 2024

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Guidelines

Guidelines and related publications, position statements, white papers, technical reviews, consensus statements, etc…

Am J Gastroenterol

American College of Gastroenterology Guidelines: Management of Acute Pancreatitis.

The safety of early refeeding and importance in preventing complications from AP are addressed. This guideline will provide an evidence-based practical approach to the management of patients with AP.

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The Role of Imaging for Gastrointestinal Bleeding: Consensus Recommendations From the American College of Gastroenterology and Society of Abdominal Radiology.

A comparison of advantages and limitations relative to endoscopic examinations is also included. Finally, consensus statements and recommendations on technical parameters and utilization of radiologic techniques for GI bleeding are provided.

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Clin Gastroenterol Hepatol

AGA Clinical Practice Update on Management of Iron Deficiency Anemia: Expert Review.

BEST PRACTICE ADVICE 15: Endoscopic treatment of angioectasias should be accompanied with iron replacement. Medical therapy for small-bowel angioectasias should be reserved for compassionate treatment in refractory cases when iron replacement and endoscopic therapy are ineffective.

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J Hepatol

EASL Clinical Practice Guidelines on genetic cholestatic liver diseases.

The management of these diseases generally takes place in a tertiary referral centre, in order to provide up-to-date approaches and expertise. These CPGs are intended to support hepatologists (for paediatric and adult patients), residents and other healthcare professionals involved in the management of these patients with concrete recommendations based on currently available evidence or, if not available, on expert opinion.

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EASL position paper on clinical follow-up after HCV cure.

Finally, guidance is provided on the monitoring and treatment of reinfection in at-risk patients. The recommendations are based on the best available evidence and are intended to help healthcare professionals involved in the management of patients after treatment for HCV.

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EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD).

No MASH-targeted pharmacotherapy can currently be recommended for the cirrhotic stage. Management of MASH-related cirrhosis includes adaptations of metabolic drugs, nutritional counselling, surveillance for portal hypertension and HCC, as well as liver transplantation in decompensated cirrhosis.

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Meta-analysis

meta-analyses and systematic reviews

Aliment Pharmacol Ther

Network meta-analysis: Comparative onset of early effect of biologics and small molecules in moderately to severely active luminal Crohn's disease.

We found infliximab to be ranked highest and superior to al other agents but risankizumab and adalimumab, demonstrating the highest probability of early induction of remission. Upadacitinib and risankizumab induced the highest clinical responses in bio-exposed patients. However, infliximab was not investigated in this population.

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Am J Gastroenterol

Effectiveness of Bile Acid Sequestrants in Microscopic Colitis and Utility of Bile Acid Testing: A Systematic Review and Meta-Analysis.

One third of patients with MC had BAM and almost two thirds of al patients responded to BAS with limited side effects. Patients with MC and BAM were more likely to respond to therapy, supporting the value of bile acid testing.

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Clin Gastroenterol Hepatol

Perianal fistulizing Crohn's disease-associated anorectal and fistula cancers: systematic review and expert consensus.

Inflammatory bowel disease (IBD) clinicians should be aware of the risk of PFCD-associated anorectal and fistula cancers in al patients with PFCD. The TOpClass consortium consensus statements outlined herein offer guidance in managing this challenging scenario.

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STOPPING NUCLEOS(T)IDE ANALOGUES IN CHRONIC HEPATITIS B USING HBSAG THRESHOLDS: A META-ANALYSIS AND META-REGRESSION.

While EOTqHBsAg thresholds, ethnicity and followup duration strongly predict HBsAg loss, this is not true for VR and BR, hence stopping NA therapy should be considered cautiously.

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Endosc Int Open

Safety of cold resection of non-ampullary duodenal polyps: Systematic review and meta-analysis.

Cold resection is associated with lower odds of delayed bleeding compared with hot resection for duodenal tumors. There was a trend toward higher odds of perforation and recurrence following hot resection, but this trend was not statistically significant.

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Endoscopy

EUS vs. ERCP-guided primary drainage of inoperable distal malignant biliary obstruction: systematic review and meta-analysis of randomized controlled trials.

EUS-BD showed a statistically significant lower re-intervention rate compared to ERCP, but with similar technical success rate, stent patency, clinical success rate and safety profile, while in the subgroup of EUS-LAMS, the technical success was better than ERCP Keywords distal; biliary obstruction; efficacy; safety.

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Gastrointest Endosc

Effect of the number of passes on diagnostic performance of EUS-fine needle biopsy of solid pancreatic masses: A systematic review and meta-analysis.

Two passes with Franseen or Fork-tip needles and three passes with any FNB needle suffice to provide optimal diagnostic performance for EUS-FNB of SPMs, without additional diagnostic benefits with more passes. Our results can inform future guidelines and quality benchmarks.

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Indirect comparison of various lumen apposing metal stents for EUS-guided biliary and gallbladder drainage: A systematic review and meta-analysis.

AXIOS and SPAXUS stents demonstrate similar pooled technical and clinical success rates. Adverse events occurred in 23.6% patients (AXIOS stent) and 9.5% patients (SPAXUS stent) during EUS-GB.

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RISK FACTORS FOR METACHRONOUS COLORECTAL CANCER OR ADVANCED LESIONS AFTER ENDOSCOPIC RESECTION OF SERRATED POLYPS: A SYSTEMATIC REVIEW AND META-ANALYSIS.

CRC risk is significantly higher in patients with baseline advanced SP after 4·9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SP.

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Original articles

RCT, clinical trials, retrospective studies, etc…

Aliment Pharmacol Ther

Characterisation of an outbreak of acute liver injury after ingestion of plant-based food supplement.

Natural food products are increasingly ubiquitous and may unexpectedly cause significant illness. All clinicians should inquire whether patients are consuming natural food products or herbal supplements and consider them as a potential cause of liver injury.

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Continuing or stopping 5-aminosalicylates in patients with inflammatory bowel disease on anti-TNF therapy: A nationwide population-based study.

In this nationwide population-based study, discontinuing 5-ASA after starting anti-TNF therapy was not associated with an increased risk of adverse events in patients with IBD.

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Financial hardship and cost-related nonadherence to medication in patients with liver disease in the United States.

Financial hardship from medical bills and cost-related nonadherence to medication can negatively impact individuals with CLD and need further evaluation.

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How effective are experienced hepatologists at staging fibrosis using non-invasive fibrosis tests in patients with metabolic dysfunction-associated steatotic liver disease?

Adhering to the recommended algorithmic approaches using NITs to stage fibrosis tended to perform more accurately than less-structured clinician NIT-based assessments conducted by experienced hepatologists.

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Psychiatric disorders in patients with hepatocellular carcinoma: A large US cohort of commercially insured individuals.

Nearly 2 of 10 patients with HCC were diagnosed with a psychiatric condition after cancer diagnosis with unique sociodemographic and clinical risk factors identified. This highlights a risk for increased psychological burden in need of early evaluation and treatment among patients with newly diagnosed HCC.

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Repeatability of vibration-controlled transient elastography versus magnetic resonance elastography in patients with cirrhosis: A prospective study.

Both VCTE and MRE demonstrated increased measurement variability with disease severity. However, MRE outperformed VCTE in terms of technical repeatability in patients with cirrhosis. These repeatability estimates may improve the qualification of NITs in practice.

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The evaluation and analysis of irritable bowel syndrome-related short videos on social media (TikTok).

Videos posted by medical professionals are easier to understand and to act on, and are more reliable and unbiased, and more likely to recommend shared decision making about treatment.

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Treatment of inflammatory bowel disease with steroid-sparing medications is age-dependent - Results from a Danish nationwide cohort study, 2000-2018.

There are significant differences in the use of steroid-sparing medication between age of onset, even after two courses with systemic steroids. High frailty could account for some of these differences in elderly-onset IBD.

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Am J Gastroenterol

Gender trends in authorship of gastroenterology randomized controlled trial literature.

Results The proportion of females increased from 25.4% to 36.8% and from 14.3% to 24.8% among first and last authors, respectively. Smaller increases in female authorship occurred in most subgroups, though there were proportionately fewer females among authors in high-impact journals and advanced therapeutic endoscopy publications.

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Long-term outcomes of additional surgery after endoscopic resection versus primary surgery for T1 colorectal cancer.

ER prior to AS for T1 CRC had no adverse effect on patients' long-term outcomes, including the 5-year OS rate. ER is a viable first-line treatment option for endoscopically resectable T1 CRC.

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Opioids and the Gastrointestinal Tract: The Role of Peripherally Active µ-Opioid Receptor Antagonists in Modulating Intestinal Permeability.

In this review we briefly describe the physiology of the gastrointestinal epithelial border and discuss the impact of opioids on gastrointestinal function. Finally, we consider the use of peripherally active µ-opioid receptor antagonists to treat disrupted intestinal permeability resulting from opioid use and discuss the potential for improved morbidity and mortality in patients treated with methylnaltrexone for opioid-induced bowel disorders.

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SELF-REPORTED NON-CELIAC GLUTEN SENSITIVITY IN ITALIAN YOUNG ADULTS: A CROSS-SECTIONAL STUDY. A DIETARY FAD?

The high prevalence of people reporting symptoms after gluten ingestion requires that the diagnosis of NCGS should be ascertained with a double-blind controlled study to limit the number of people who improperly approach a gluten-free diet.

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Clin Gastroenterol Hepatol

Provider Specialization in Inflammatory Bowel Diseases: Quality of Care and Outcomes.

IBD care for adults varies by provider specialization. Given the evolving complexity, novel methods may be needed to standardize care.

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Real-world effectiveness of fecal microbiota transplantation for first or second Clostridioides difficile infection.

Repeated FMT treatments demonstrate high effectiveness in managing patients with first or second CDI. Forwarding FMT in CDI treatment guidelines could improve patient survival.

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The Role of Pancreatitis Risk Genes in Endocrine Insufficiency Development After Acute Pancreatitis in Children.

In this cohort of children with AP, pancreatitis risk genes and AP disease severity were associated with pre-DM or DM development post AP.

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Endosc Int Open

Comprehensive analysis of adverse events associated with transmural use of LAMS in patients with liver cirrhosis: International multicenter study.

Our study demonstrated that mainly in patients with Child-Pugh scores A and B cirrhosis and despite the presence of mild-to-moderate ascites in over half of cases, the majority of AEs were mild and could be managed conservatively. Further studies are warranted to verify the safety of LAMS in cirrhotic patients.

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Feasibility and safety of a novel plastic stent designed specifically for endoscopic ultrasound-guided pancreatic duct drainage.

The novel plastic stent shows potential as a useful and safe tool in EUS-PD.

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Outcomes in colorectal endoscopic submucosal dissection for large protruded lesions: A retrospective multicenter study.

Treating LPLs through colorectal ESD presents significant challenges, especially in patients with fibrosis and MRS. This study highlights the importance of recognizing these complexities, and that more reliable resection strategy must be established for accurate pathological evaluation.

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Single-center experience with intraprocedural cleansing system to improve inadequate bowel preparation during colonoscopy.

We found the device efficacious and easy to use with low procedure failure rates, but it does come with a learning curve. We suspect that adoption of this device mutually will benefit patients and health systems with the potential to improve resource utilization.

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The white ring sign is useful for differentiating between fundic gland polyps and gastric adenocarcinoma of the fundic gland type.

WRS positivity and negativity demonstrate high diagnostic accuracy and inter-rater reliability for FGPs and GA-FGs, respectively, suggesting that WRS is a useful novel marker for distinguishing between FGPs and GA-FGs.

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Endoscopy

A comparison of novel electrocautery-enhanced lumen-apposing metal stents and plastic stents in EUS-guided drainage of infected walled-off necrosis: A multicenter randomized study.

We found no significant difference in the total number of DEN procedures between LAMS and PS for managing infected WON. The only statistically significant finding was a higher clinical success rate at 8 weeks for patients treated with EC-LAMS. The use of EC-LAMS did not result in any adverse events, such as bleeding or buried LAMS syndrome, within the study duration.

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FEASIBILITY AND SAFETY OF A DEDICATED CAUTERY-ENHANCED TUBULAR SELF-EXPANDABLE METAL STENT FOR ENDOSCOPIC ULTRASOUND-GUIDED HEPATICOGASTROSTOMY.

Dedicated cautery-enhanced tubular SEMS for EUS-HGS can simplify the procedure and enhance its safety and efficacy. This innovation shows promise for improving patient outcomes, although further studies are needed to validate these findings in a broader patient population.

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Sessile serrated lesion prevalence and factors associated with their detection: a post-hoc analysis of a multinational randomized controlled trial from Asia.

The prevalence of SSLs in Asia is 4.0%. Use of LCI or a transparent cap, greater endoscopist experience, and longer withdrawal time were al associated with increased SSL detection.

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Gastroenterology

Anti-Integrin αvβ6 Autoantibodies Are a Novel Biomarker That Antedate Ulcerative Colitis.

Anti-integrin αvβ6 autoantibodies precede the clinical diagnosis of UC by up to 10 years and are associated with adverse UC-related outcomes.

Pubmed   Journal   ReadQx   PMC

Organoids for functional precision medicine in advanced pancreatic cancer.

We report the largest prospective study aiming at implementing PDO-based FPM and identify very robust predictive values in this clinical setting. In a clinically relevant turnaround-time, we identify putative hits for 91% of patients, providing unexpected potential survival benefits in this very aggressive indication. While this remains to be confirmed in interventional precision oncology trials, PDO collection already provide powerful opportunities for drugs and combinatorial treatment development.

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Gastrointest Endosc

A new artificial intelligence system for both stomach and small bowel capsule endoscopy.

Our study shows that the newly upgraded DL-based algorithm SS Plus can detect GI lesions and help improve the diagnostic performance of junior endoscopists in interpreting CE videos.

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Investigation of disinfection failure of flexible gastrointestinal endoscope due to Burkholderia cepacia contamination in irrigation tubing.

The primary reason for endoscope disinfection failure is the contamination of the sink irrigation tubing by the B. cepacia bacteria. These findings emphasize the need for thorough cleaning of irrigation tubings in integrated endoscopic washing workstations, which is generally neglected in routine maintanance.

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Modified submucosal tunnelling endoscopic septum division for symptomatic esophageal diverticula is effective and safe: a prospective case series (with video).

The modified STESD method for esophageal diverticula is effective and safe, further large prospective controlled studies are needed.

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Virtual Reality intervention to improve quality of care during Colonoscopy: A hybrid type 1 randomized controlled trial.

VR can be used as a nonpharmacological method for pain management and for overcoming anxiety and discomfort during colonoscopy. VR can improve patients' satisfaction and diminish the need for sedative medications; accordingly, it has the potential to promote cooperation and compliance among patients and increase screening colonoscopy rates. NCT05723861.

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Gut

PARP-1 selectively impairs KRAS-driven phenotypic and molecular features in intrahepatic cholangiocarcinoma.

Objective Intrahepatic cholangiocarcinoma (iCCA) is the second most common primary liver cancer with limited therapeutic options. signalling.

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Patient-derived organoid biobank identifies epigenetic dysregulation of intestinal epithelial MHC-I as a novel mechanism in severe Crohn's Disease.

Our study has identified epigenetically regulated intestinal epithelial MHC-I as a novel mechanism in CD pathogenesis.

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Hepatology

Bile metabolic fingerprints distinguish biliary tract cancer from benign biliary diseases.

Our findings confirmed the improved diagnostic capabilities of BileMet assay in a clinical setting. If applied, the BileMet assay enables intraoperative testing and fast medical decision-making for cases with suspected malignancy where brush cytology detection fails to support malignancy, ultimately reducing the economic burden by over 90%.

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Bintrafusp alfa and chemotherapy as first-line treatment in biliary tract cancer: A randomized phase ⅔ trial.

BA+GemCis did not provide a clinically meaningful benefit compared to GemCis alone as first-line treatment for BTC and the study was discontinued early (terminated August 20, 2021).

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Real-world evidence for factors associated with maintenance treatment practices among U.S. adults with autoimmune hepatitis.

Long-term prednisone therapy remains common, and unexpectedly higher among patients with comorbidities potentially aggravated by corticosteroids. The greater use of corticosteroid-based therapy with highly experienced providers may reflect more treatment-refractory disease.

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J Hepatol

Efficacy, tolerability and pharmacokinetics of survodutide, a glucagon/glucagon-like peptide-1 receptor dual agonist, in cirrhosis.

Survodutide is generally tolerable in people with compensated or decompensated cirrhosis, does not require pharmacokinetic-related dose adjustment, and may improve liver-related non-invasive tests, supporting its investigation for MASH-related cirrhosis. Clinical trial number; ClinicalTrials.gov identifier NCT05296733. Impact and implications Survodutide is a glucagon receptor/glucagon-like peptide-1 receptor dual agonist in development for treatment of metabolic dysfunction-associated steatohepatitis (MASH), which causes cirrhosis in ∼20% of cases. This trial delineates the pharmacokinetic and safety profile of survodutide in people with compensated or decompensated cirrhosis, and revealed associated reductions in liver fat content, markers of liver fibrosis and body weight. These findings have potential relevance for people with MASH-including those with decompensated cirrhosis, who are usually excluded from clinical trials of investigational drugs. Based on this study, further investigation of survodutide for MASH-related cirrhosis is warranted.

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Reviews&Editorials

Plenty of the editorials are available as full text through the publisher website using the provided link

Aliment Pharmacol Ther

Editorial: Mucosal healing with steroids: Once upon a time in ulcerative colitis.

Pubmed   Journal   ReadQx 

Editorial: Sonographic assessment of colonic content: A new tool for constipation?

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Review article: Hepatic steatosis and its associations with acute and chronic liver diseases.

Diverse liver pathologies are associated with hepatic steatosis, with MASLD being the most important contributor. The biogenesis and dynamics of LDs in hepatocytes are complex and warrant further investigation. Organellar interfaces permit co-regulation of lipid metabolism to match generation of potentially toxic lipid species with their LD depot storage.

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Gastroenterology

Presentation of the 2024 AGA Distinguished Achievement Award in Basic Science to Jerrold R. Turner, MD, PhD, AGAF.

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Gut

Nuclear receptors: pathophysiological mechanisms and drug targets in liver disease.

We discuss the potential benefit of novel therapeutic approaches simultaneously targeting multiple NRs, which would not only reactivate the hepatic NR network and restore hepatocyte identity but also impact intercellular and interorgan interplays whose importance to control liver functions is further defined. Finally, we highlight the need of considering individual parameters such as sex and disease stage in the development of NR-based clinical strategies.

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Opening the doors of precision medicine: novel tools to assess intestinal barrier in inflammatory bowel disease and colitis-associated neoplasia.

Novel molecules, dietary interventions and microbiome modulation strategies aim to restore, reinforce, or modulate the gut-brain axis. These advancements have the potential for transformative and personalised approaches to managing IBD.

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J Hepatol

Immunotherapy for hepatocellular carcinoma: the next evolution in expanding access to liver transplantation.

Ultimately, the goal of immunotherapy in this population will be to effectively expand access to liver transplantation while preserving pre- and post-transplant outcomes. In this review, we discuss the mechanisms supporting combination immunotherapy, summarize key recent clinical data from major immunotherapy trials, and explore how immunotherapy can be applied in the neoadjuvant setting prior to liver transplantation in selected high-risk patients.

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Integration of new technologies in the multidisciplinary approach to primary liver tumours: The next-generation tumour board.

Navigating this evolution also requires a focus on enhancing basic, translational, and clinical research, as well as boosting clinical trials through an upgraded use of MDTBs as hubs for scientific collaboration and raising literacy about AI and new technologies. In this review, we will delineate the current unmet needs in the clinical management of primary liver cancers, discuss our perspective on the future role of MDTBs in primary liver cancers ("next generation" MDTBs), and unravel the potential power and limitations of novel technologies that may shape the multidisciplinary care landscape for primary liver cancers in the coming decade.

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Miscellaneous

misc publications eg case reports, tools of the trade, images of the month, etc…

Am J Gastroenterol

Colorectal Cancer Screening: Time to Spring Forward.

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Comments on Pancreatic Enzyme Use Reduces Pancreatitis Frequency in Children With Acute Recurrent or Chronic Pancreatitis: A Report From INSPPIRE.

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Response to Biswas et al.

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Timing Is Everything: The Lifesaving Potential of Early Medical Therapy in Acute Severe Ulcerative Colitis.

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Clin Gastroenterol Hepatol

Abdominal pain, jaundice, and photosensitivity.

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Age Affects Esophageal Secondary Peristalsis More Than Primary as Assessed by FLIP Panometry and High-Resolution Manometry.

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An Unusual Cause of Hilar Biliary Obstruction.

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Incidental Mixed Adenoma-Neuroendocrine Neoplasm (MiNEN) of Duodenum and Whipple disease.

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Plummer-Vinson Syndrome: Classic triad of iron deficiency anemia, dysphagia, and esophageal webs.

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Prevalence of SLD Subtypes and Association with Metabolic Risk Factors in the Framingham Heart Study.

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Very low-density lymphadenopathy in Whipple disease.

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Endosc Int Open

Early diagnosis of pancreatic cancer via pancreatic juice cytology with a cell-block method in a patient with altered anatomy.

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Endoscopy

A technique for preventing clip snagging during the use of a rotating function endoscopic clip.

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Comprehensive endoscopic management of recurrent esophageal wall abscess revealing concomitant eosinophilic esophagitis.

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Congenital gastric ectopic pylorus: a rare gastric malformation.

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Cystogastrostomy as an alternative treatment for recurrent huge infected hepatic cyst.

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Effectiveness of gel-immersion endoscopy for examination for suspected pancreaticobiliary maljunction.

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Endoscopic papillectomy of a rare isolated ampullary hamartoma.

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Endoscopic ultrasound-guided cyanoacrylate injection into the perforating vein for high-risk gastric varices.

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Esophageal pneumatosis and hematomatosis concomitant with achalasia.

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First report of the use of a digital single-operator cholangioscope for endoscopic direct diverticulitis therapy.

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Gastric endoscopic submucosal dissection through a gastrostomy using a newly developed thin endoscope.

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Novel grasp-and-snare technique for efficient endoscopic necrosectomy of walled-off necrosis.

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Peroral cholangioscopy-guided diagnosis and treatment of Clonorchis sinensis liver flukes.

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Splenic artery aneurysm masquerading as an intraductal tubulopapillary neoplasm diagnosed by contrast-enhanced endoscopic ultrasound.

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The "echo-free space" technique: A safe and reliable method for endoscopic ultrasound scope insertion into the esophagus.

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The sword in the wall: managing biliary stents embedded in the duodenal wall following ERCP for biliary strictures after liver transplantation in an adult and a pediatric patient.

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We are not in a Woody Allen film yet.

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Gastroenterology

Defining the role of immune microniches in intestinal effector Treg cell functionality.

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Human Hepatocytes Can Give Rise To Intrahepatic Cholangiocarcinomas.

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Gut

GI snapshot: arrhythmia, dysphagia and weight loss in a 71-year-old man.

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Hepatology

Baseline viral load in chronic hepatitis B may be clinically significant but must be interpreted with caution.

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REPLY: The exact predictive value of HBcrAg and HBV RNA in serological status and disease activity in CHB.

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The exact predictive value of HBcrAg and HBV RNA in serological status and disease activity in CHB.

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Letters&Replies

Letters to the editors and authors’ replies

Aliment Pharmacol Ther

Editorial: Mucosal healing with steroids-Once upon a time in ulcerative colitis. Authors' reply.

Pubmed   Journal   ReadQx 

Editorial: Sonographic assessment of colonic content-A new tool for constipation? Authors' reply.

Pubmed   Journal   ReadQx 

Letter: Breaking new ground-Understanding the role of ATI-free diet in managing MASLD-Authors' reply.

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Letter: Breaking new ground-Understanding the role of ATI-free diet in managing MASLD.

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Letter: Third-line therapy in acute severe ulcerative colitis, exploring the uncertainty and unanswered questions-Authors' reply.

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Clin Gastroenterol Hepatol

Aspirin-related chemoprevention of GI cancers and bleeding-related mortality in Helicobacter pylori-eradicated patients.

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Ensuring Consistency and Accuracy in Evaluating ChatGPT4 for Clinical Recommendations.

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Response to Yuxin Wang et al.

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Screening endoscopy in patients with advanced chronic liver disease - is it all about varices?

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Screening for Social Determinants of Health in Underserved Populations to Promote Better Outcomes in ALD and MASLD.

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Gut

Porcine-derived pancreatic enzyme replacement therapy linking to chronic hepatitis E: broad implications.

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J Hepatol

Biomarker predictors and LRT strategies for HCC recurrence post-liver transplantation: A comment.

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EVIDENCE-BASED FAILURE OF STAGE HIERARCHY THERAPEUTIC APPROACH TO HCC.

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Non-acute decompensation cannot be ignored in future research and clinical practice.

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Reevaluating Myosteatosis Criteria in Cirrhosis: Fluid and Gender Considerations.

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Reply 'Exploring hepatocellular carcinoma risks in sub-Saharan African and Afro-Surinamese individuals with chronic hepatitis B living in Europe'.

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